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Background Intra-articular injections for the treatment of knee pain due to osteoarthritis are performed when conservative therapies have failed. The intra-articular injection of lidocaine may be an effective treatment modality due to its neuronal membrane-stabilizing effect and long-lasting anti-inflammatory action. In this study, we compared the efficacy of intra-articular 0.5% lidocaine versus saline injection on pain, stiffness and physical function in patients with osteoarthritis. Methods Patients with osteoarthritis were randomly allocated to two groups. Group I (n = 26) received 7 mL 0.5% lidocaine and group II (n = 26) received 7 mL saline into the painful knee for a series of three injections spaced by 1 week intervals under ultrasound guidance. Knee pain was measured with a numeric rating score (NRS) at baseline and 3 months after the 3rd injection. WOMAC scales, including pain (WOMAC-P), stiffness (WOMAC-S) and physical function (WOMAC-F), were assessed and recorded at baseline, 30 minutes after the 1st injection, immediately prior to the 2nd and 3rd injections and 3 months after the 3rd injection. Results Demographic data were comparable between groups. The NRS after 3 months was significantly lower in group I (P = 0.001). The WOMAC-P, immediately prior to the 3rd injection and 3 months afterwards, was significantly lower in group I (P = 0.006, P = 0.001, respectively). The WOMAC-S was improved prior to the 3rd injection and sustained until 3 months in group I (P = 0.035, P = 0.004, respectively). The WOMAC-F was improved after the 1st injection and sustained until 3 months in group I (P = 0.002, P Conclusions Intra-articular 0.5% lidocaine injection under ultrasound guidance has a potential role in the management of chronic knee pain due to osteoarthritis for a 3-month period.

Amaç: Bu retrospektif çalışmada hastanemizde laparaskopik bariatrikcerrahi uygulanan hastalardaki anestezi deneyimimizin aktarılması veperioperatif yönetimin literatür eşliğinde tartışılması amaçlanmıştır.Gereç veYöntem: Obezite cerrahisi geçiren ASA risksınıflaması II-III olan 62 hasta retrospektif olarak değerlendirilmiştir.Hastaların demografik özellikleri, cerrahinin süresi, peroperatif dönemdegörülen komplikasyonlar, hastanede kalış süresi kaydedilmiştir.Bulgular: Hastaların yaş aralığı 19 ile 59 arasında değiştiği ve %72.6’sının kadınolduğu tespit edildi. Ortalama operasyonsüresi 167 dakika, hastanede kalış süresi 5 gündür. İntroperatif dönemdegörülen komplikasyonlar arasında taşikardi, hipertansiyon ve aritmi yeralmaktadır. Takiplerde 6 (%9.7) hastanın tekrar operasyona alındığı, hastalarıntamamının sağlıklı şekilde hastaneden taburcu edildiği tespit edildi.Sonuç:Laparaskopik obezite cerrahisinde oluşabilecekkomplikasyonların önlenmesinde donanımlı bir ekip ve takım çalışması ilebirlikte iyi bir preoperatif hazırlık, tromboemboli proflaksisi, sıkıhemodinami ve kan gazı takibi güvenli bir anestezi için gereklidir., Purpose: The aim of this study was topresent our experience in patients who underwent laparoscopic bariatric surgery and to discuss the current literature on theperioperative management.Material andMethods: Sixty two patients with ASA riskclassification II-III were evaluated retrospectively who underwent obesity surgery inour hospital. Demographiccharacteristics of the patients, surgical time, complications that seen in theperioperative period and the length of hospital stay were recorded.Results: The age of thepatients ranged from 19 to 59 years and 75.9% of them were female. Meanoperation time was 167 minutes and the length of hospital stay was 5 days. Complications seen during intraoperative period were tachycardia,hypertension and arrhythmia. In the following days, 6 (9.7%) patients were re-operated and there was no mortality.Conclusion: The prevention of complications that may occur inlaparoscopic obesity surgery is required with a equipped team and teamwork, agood preoperative preparation, thromboembolism prophylaxis, tight hemodynamicsand blood gas monitoring for safe anesthesia.

BACKGROUND AND OBJECTIVE: We compared the efficacy of intravenous (IV) paracetamol versus dipyrone via patient-controlled analgesia (PCA) for postoperative pain relief in children. METHODS: The study was composed of 120 children who had undergone elective tonsillectomy after receiving general anesthesia. Patients were divided into 3 groups according to the dosage of postoperative intravenous-patient-controlled analgesia: paracetamol, dipyrone, or placebo. Pain was evaluated using a 0- to 100-mm visual analog scale and 1- to 4-pain relief score at 30 min, 1, 2, 4, 6, 12, and 24 h postoperatively. Pethidine (0.25 mg kg-1) was administered intravenously to patients requiring rescue analgesia. Pethidine requirements were recorded during the first 24 h postoperatively, and treatment related adverse effects were noted. RESULTS: Postoperative visual analog scale scores were significantly lower with paracetamol group compared with placebo group at 6 h (p < 0.05), dipyrone group compared with placebo group at 30 min and 6 h (p < 0.05). No significant differences regarding visual analog scale values at 1, 2, 4, 12, and 24 h were found. No significant differences were found between groups with respect to pain relief score (p > 0.05). Postoperative pethidine requirements were significantly lower with paracetamol and dipyrone groups compared with placebo group (62.5%, 68.4% vs 90%, p < 0.05). No significant differences were found between groups with respect to nausea, vomiting and the any other adverse effects of the drugs (p > 0.05). CONCLUSIONS: Paracetamol and dipyrone have well tolerability profile and effective analgesic properties when administered IV-PCA for postoperative analgesia in children after tonsillectomy. JUSTIFICATIVA E OBJETIVO: Comparamos a eficácia da administração de paracetamol versus dipirona em analgesia controlada pelo paciente (PCA) por via intravenosa (IV) para alívio da dor no período pós-operatório em crianças. MÉTODOS: O estudo foi composto por 120 crianças submetidas à tonsilectomia sob anestesia geral. Os pacientes foram divididos em três grupos de acordo com a dose IV de analgesia controlada pelo paciente no pós-operatório: paracetamol, dipirona ou placebo. A dor foi avaliada com uma escala visual analógica de 0-100 mm e escore de 1-4 para alívio da dor nos tempos de 30 minutos, uma, duas, quatro, seis, 12 e 24 horas de pós-operatório. Petidina (0,25 mg kg-1) foi administrada IV aos pacientes que precisaram de analgesia de resgate. A necessidade de petidina foi registrada durante as primeiras 24 horas de pós-operatório e os efeitos adversos relacionados ao tratamento foram registrados. RESULTADOS: Os escores da escala visual analógica no pós-operatório foram significativamente menores no grupo paracetamol em comparação com o grupo placebo em seis horas (p < 0,05) e no grupo dipirona em comparação com o grupo placebo em 30 minutos e seis horas (p < 0,05). Não houve diferença significativa em relação aos valores da escala visual analógica nos tempos avaliados de uma, duas, quatro, 12 e 24 horas. Não houve diferença significativa entre os grupos quanto ao escore de alívio da dor (p > 0,05). A necessidade de petidina foi significativamente menor nos grupos paracetamol e dipirona em comparação com o grupo placebo (62,5%, 68,4% vs. 90%, p < 0,05). Não houve diferença significativa entre os grupos em relação à incidência de náusea, vômito e outros efeitos adversos dos medicamentos (p > 0,05). CONCLUSÕES: Paracetamol e dipirona têm um perfil de boa tolerabilidade e propriedades analgésicas eficazes quando administrados IV para ACP no pós-operatório de crianças após tonsilectomia.

ResumoJustificativa e objetivoA sedação em paciente dependente de diálise com doença renal em estágio terminal (DRET) requer cautela como resultado da administração de altas doses de sedativos e suas complicações. Os regimes de sedação com múltiplas drogas podem ser superiores e vantajosos em relação ao consumo menor de drogas e aos eventos adversos que ocorrem facilmente em pacientes com DEET. Avaliamos os efeitos da pré‐medicação com dexmedetomidina sobre o consumo de propofol, os níveis de sedação com os escores da Observer's Assessment of Alertness and Sedation (OAA/S) e do índice bispectral (BIS), as alterações hemodinâmicas e os potenciais efeitos colaterais em pacientes geriátricos com DRET submetidos à cirurgia para fratura de quadril sob raquianestesia.MétodoNeste estudo randômico, controlado e duplo‐cego, 60 pacientes idosos (idade≥65 anos), com DRET e fratura de quadril, agendados para fixação intramedular de haste femoral anterógrada foram designados para grupos para receberam infusão intravenosa de solução salina (Grupo C) ou pré‐medicação com infusão de 0,5mg kg/10min de dexmedetomidina (DEX) (Grupo D). Todos os pacientes receberam infusão de propofol após a indução da raquianestesia.ResultadosO consumo total de propofol, a dose de propofol necessária para os níveis‐alvo de sedação de acordo com os escores da OAA/S, os valores do BIS e os tempos de recuperação foram significativamente menores no Grupo D (p

Amaç: Renal transplantasyon son dönem böbrek yetmezliği hastalarında hemodiyalizle karşılaştırıldığında yüksek yaşam kalitesi sağlayan bir yöntemdir. Son dönem böbrek yetmezliğinde volüm dağılımı, ilaç metabolizması, atılımındaki değişiklikler nedeniyle anestezi tekniği özenle planlanmalıdır. Total intravenöz anestezi, inhalasyon anestezisi, rejyonel tekniklerin sonuçları araştırılmaktadır. Çalışmada Başkent Üniversitesi Tıp Fakültesi Adana Uygulama ve Araştırma Merkezi"nde canlı ve kadaverik donörden renal transplantasyon uygulanan 77 hastada total intravenöz anestezi deneyimimizin aktarılması amaçlanmıştır. Materyal ve Metod: Anestezi indüksiyonu propofol 2mg/kg, fentanil 1µg/kg ile sağlandı, roküronyum bromürle (0.4-0.5mg/kg) entübasyon gerçekleştirildi. İdame total intravenöz anesteziyle (propofol, 50µg/kg/dk; remifentanil, 0.25µg/kg/dk infüzyon) sağlandı. İntraoperatif sıvı, idrar miktarı kaydedildi. Preemptif multimodal analjezide preinsizyonel 15mg/kg intravenöz parasetamol, 0.1mg/kg intramüsküler morfin uygulandı. Postoperatif analjezide intravenöz hasta kontrollü (meperidin 10mg bolus, kilitli kalma süresi 20 dakika) kullanıldı. Postoperatif ağrı vizüel analog skala, sedasyon düzeyleri Ramsey Sedasyon Skalası kullanılarak kaydedildi. Bulgular: Canlı donörden transplantasyon sayısı 64(83.1%), kadaverik donörden transplantasyon sayısı 13 (16.9%) idi. Canlı ve kadaverik donörden böbrek transplantasyonu yapılan hastalarda intraoperatif verilen mayi miktarında istatistiksel olarak anlamlı fark gözlenmezken; intraoperatif çıkarılan idrar miktarının canlı donörden böbrek nakli uygulanan hastalarda anlamlı olarak yüksek olduğu saptandı(p

Objective To evaluate the clinical success rate, safety, and usefulness for intraoperative central venous pressure monitoring, and the intravenous access of the supraclavicular subclavian vein approach when compared with the infraclavicular subclavian vein approach and the internal jugular vein approach for central venous catheterization during open-chest cardiac surgery. Design A prospective, randomized, single-center study. Setting A university hospital. Participants One hundred ninety-five patients scheduled for open-chest cardiac surgery. Interventions The study population consisted of patients for whom central vein catheterization was intended during cardiac surgery. Patients were randomized to 3 groups according to the route of central vein catheterization: the supraclavicular group: the supraclavicular approach for the subclavian vein (n = 65); the infraclavicular group: the infraclavicular approach for the subclavian vein (n = 65); and the jugular group: the internal jugular vein approach (n = 65). After the induction of anesthesia, central venous catheterization was performed according to the assigned approach. Measurements and Main Results The success rates for the assigned approach were 98%, 98%, and 92% for the supraclavicular, infraclavicular, and jugular groups, respectively (p > 0.05). The success rates in the first 3 attempts in patients who were catheterized successfully according to the assigned approach were 96%, 100%, and 96% for the supraclavicular, infraclavicular, and jugular groups, respectively (p > 0.05). There was no difference among groups in catheter insertion time (p > 0.05). After sternal retraction, central venous pressure trace loss and difficulty in fluid infusion were significantly more frequent in the infraclavicular group (21%) when compared with the supraclavicular (3%) and jugular groups (0%) (p = 0.01). There was no difference among groups in terms of catheter malposition, complications during catheterization, and rate of catheter-related infection. Conclusion The supraclavicular approach for subclavian vein catheterization is an acceptable alternative for central venous access during cardiac surgery in terms of procedural success rate, ease of placement, rate of complications, and usability after sternal retractor expansion.

We analyzed the results of patients who underwent percutaneous nephrolithotomy (PCNL) for management of kidney stone disease under combined spinal-epidural anesthesia and compared surgical parameters and outcomes with a matched control group who underwent PCNL under general anesthesia.A total of 82 patients were studied in two groups. Group 1 (n = 45) consisted of the patients who underwent general anesthesia, and group 2 (n = 37) comprised those who received combined spinal-epidural anesthesia.The mean ages of patients in groups 1 and 2 were 45 +/- 15 and 44 +/- 15 years, respectively. The mean areas of the stones in groups 1 and 2 were 734 +/- 386 mm(2) and 731 +/- 394 mm(2), respectively. There were no significant differences between groups 1 and 2 among surgical parameters, including age, stone area, operative time, irrigation fluids, fluoroscopy time, delta hemoglobin, and hospitalization time (P = 0.439). At the end of the surgery, stone-free rates were 76% in group 1 and 81% in group 2; clinically insignificant residue fragments rates were 24% in group 1 and 19% in group 2. The difference was statistically insignificant between the groups (P = 0.543).We consider that combined spinal-regional anesthesia is a feasible technique in PCNL operations because the efficacy and safety were not affected. Further investigations with larger series are needed.

The purpose of the paper was to assess and to compare the effectiveness and safety of patient controlled epidural analgesia using tramadol or morphine for postoperative analgesia after major urological surgeries. For patient-controlled epidural analgesia; in group I (n = 30) a loading dose of 20 mg tramadol 0.1% with a continuous infusion of 1 mg/ml at a rate of 8 ml/h was administered preemptly and in group II (n = 30) a loading dose of 2 mg morphine in 20 ml normal saline was administered and a supplemental infusion of 0.2 mg/h morphine was begun at a rate of 2 ml/h. A demand epidural bolus dose of 5 ml with a lockout time of 30 minutes and a background infusion of 8 ml/h in tramadol 0.1% group and 2 ml/h in morphine 0.01% group were administered. VAS for pain intensity, vital signs, sedation scale and side effects were monitored at 0, 15, 30 minutes and 1, 2, 3, 4, 8, 12, 24 hours during the postoperative period. Adequate analgesia was provided in all patients. VAS values were significantly lower in group II than in group I after the fourth hour measurement (p < 0.05). The incidence of nausea, vomiting and pruritius was lower in the tramadol group (p < 0.05). In conclusion we decided that, after major urologic surgery, patient-controlled epidural administration of tramadol with a continuous background infusion might provide a safe and effective analgesia with limited side effects, even though there is increased drug consumption.

Background The addition of opioids to local anesthetics contributes to the quality of spinal anesthesia and postoperative analgesia. Objective In our prospective, randomized, double-blind, controlled study, our aim was to compare the effect of low-dose sufentanil plus levobupivacaine or a fentanyl plus levobupivacaine mixture on anesthesia quality, block characteristics, newborn and mother well-being, surgeon satisfaction, and duration of postoperative analgesia. Methods Ninety-three patients were randomized into 3 groups (n = 31). Patients in Group C received 0.5% levobupivacaine (2.2 ± 0.2 mL), Group S received 2.5 µg sufentanil plus 0.5% levobupivacaine (2.2 ± 0.2 mL), and Group F received 10 µg fentanyl plus 0.5% levobupivacaine (2.2 ± 0.2 mL) intrathecally completed to a volume of 3 mL with the addition of saline in all groups. Patients’ demographics, sensory and motor block characteristics, hemodynamics, Apgar scores, umbilical blood gas values, maternal side effects, surgeon satisfaction score, time to first analgesia requirement, and additional analgesic use within 24 hours were recorded. Results In Group S and Group F, target levels of sensory and motor block were achieved more rapidly (P < 0.001). The hemodynamic values were lower (P < 0.05), and the duration of sensory blockade and the time of first analgesic requirement were longer (P < 0.001) in Group S. Additional analgesic requirement during first 24-hour period was lowest in Group S, and highest in Group C (P < 0.001). Apgar scores and umbilical blood gas samples were similar between groups. Postoperative pruritus was more frequent in Group S (P < 0.001) and surgeon satisfaction score was significantly lower in Group C (P = 0.003). Conclusions We suggest that the addition of sufentanil and fentanyl to intrathecal levobupivacaine during caesarean section surgery is more effective than the administration of levobupivacaine alone. The addition of sufentanil to levobupivacaine allowed rapid onset time for sensory and motor block levels. It also extended the duration of postoperative analgesia and led to a decrease in total analgesic requirement. ClinicalTrials.gov identifier: NCT01858090.

Phenobarbital induces specific hepatic cytochrome P-450 enzyme pathways causing increased clearance of hepatically metabolized drugs. In this study, we investigated the duration and additional anesthetic requirement during Magnetic resonance imaging (MRI) in epileptic children with or without phenobarbital monotherapy. In ASA I-II, 128 children, aged 1-10 years, were included. Group I: epileptic children without anti-epileptic therapy and Group II: children with phenobarbital monotherapy. The initial sedative drugs were 0.1 mg·kg(-1) midazolam with 2 mg·kg(-1) ketamine. An additional 1 mg·kg(-1) ketamine was administrated if required. Rescue propofol (0.5 mg·kg(-1)) was provided and repeated to maintain sedation. The duration and consumption of additional sedative requirements was recorded. The duration of initial and two consequent additional sedative requirements was shorter in Group II (P = 0.0001, P = 0.001 and P = 0.27, respectively). Additional ketamine doses required for adequate sedation were lower in Group I (P = 0.016). We suggest that the variability in response to the initial sedative agents during MRI requires titration of additive sedation with ketamine in epileptic children on phenobarbital monotherapy.

Dear Editor, Pneumorrhachis and pneumocephalus are unusual complications of inadvertent dural puncture. We present the case of pneumorrhachis and pneumocephalus in a patient with lumbar spinal stenosis who was performed epidural steroid injection by using loss of resistance technique to air. A 37-year-old man with the history of spinal stenosis, low back pain, bilateral leg pain, and neurogenic claudication was performed epidural steroid (80 mg metil prednisolone) injection in another pain clinic. He complained of severe chest pain and headache aproximately 1 hour after epidural injection in the recovery room. The anesthesiologist who attempt epidural steroid …

Background: The insertion of urinary catheters during urinary surgical interventions may lead to catheter-related bladder discomfort (CRBD) in the postoperative period. Objective: We aimed to evaluate the effect of single-dose intravenous paracetamol on CRBD. Methods: In this randomized, controlled, double-blind study, 64 patients (age 18 years, American Society of Anesthesiologists Physical Status I–II) requiring urinary bladder catheterization for percutaneous nephrolithotomy were assigned to groups that received either intravenous paracetamol (15 mg/kg) (group P) or NaCl 0.9% solution (control group [group C]) 30 minutes before the end of surgery. Patients received patient-controlled analgesia (10-mg bolus of meperidine, without infusion, 20-minute lock out) postoperatively. CRBD and pain status were assessed at 30 minutes and 1, 2, 4, 6, and 12 hours postoperatively. Postoperative meperidine requirement and patient and surgeon satisfaction were assessed. Results: Group P had significantly lower CRBD scores at all time points except at 12 hours postoperatively compared with group C (P 0.05). Total meperidine consumption was significantly higher in group C (P 0.05). Patient and surgeon satisfaction scores were significantly higher in group P (P 0.05). Conclusions: Intraoperative single-dose paracetamol was found to be effective in reducing the severity of CRBD and pain in urologic surgery. We suggest that it may be an efficient, reliable, easy-to-apply drug for CRBD. ClinicalTrials.gov identifier: NCT01652183. (Curr Ther Res Clin Exp. 2012;73:186 –194) © 2012

ResumoJustificativa e objetivosOs anti‐inflamatórios não esteroides (AINEs) são frequentemente usados para controlar a dor após artroscopia. A adição de um opiáceo oral eficaz (codeína) aos AINEs pode ser mais efetiva e diminuir o consumo de opiáceo parenteral no pós‐operatório. O objetivo deste estudo foi comparar a eficácia e os efeitos colaterais de naproxeno sódico e uma nova preparação, naproxeno sódico‐fosfato de codeína, quando administrados preventivamente para meniscectomia artroscópica.MétodosForam randomicamente divididos em dois grupos 61 pacientes para receber naproxeno sódico por via oral (Grupo N) ou naproxeno sódico‐fosfato de codeína (Grupo NC) antes da cirurgia. A cirurgia foi feita sob anestesia geral. Meperidina intravenosa foi iniciada por meio de analgesia controlada pelo paciente (ACP) para todos os pacientes. O desfecho primário foi o escore de dor na primeira hora de pós‐operatório, avaliada com a escala visual snalógica (EVA). A sedação foi avaliada com a escala de sedação de Ramsey. A primeira demanda de ACP, o consumo de meperidina no pós‐operatório, os efeitos colaterais e os dados hemodinâmicos também foram registrados.ResultadosOs grupos foram demograficamente comparáveis. As medianas dos escores EVA tanto em repouso quanto em movimento foram significativamente menores no Grupo NC comparado com o Grupo N; exceto para movimento na avaliação de 18 horas (p0,05).ConclusõesA combinação de naproxeno sódico‐fosfato de codeína forneceu analgesia mais efetiva que naproxeno sódico, sem aumentar os efeitos colaterais.AbstractBackground and objectivesNonsteroidal anti‐inflammatory drugs (NSAIDs) are frequently used to control arthroscopic pain. Addition of oral effective opioid “codeine” to NSAIDs may be more effective and decrease parenteral opioid consumption in the postoperative period. The aim of this study was to compare the efficacy and side effects of naproxen sodium and a new preparation naproxen sodium‐codeine phosphate when administered preemptively for arthroscopic meniscectomy.MethodsSixty‐one patients were randomized into two groups to receive either oral naproxen sodium (Group N) or naproxen sodium‐codeine phosphate (Group NC) before surgery. The surgery was carried out under general anesthesia. Intravenous meperidine was initiated by patient‐controlled analgesia (PCA) for all patients. The primary outcome measure was pain score at the first postoperative hour assessed by the Visual Analogue Scale (VAS). Sedation assessed by Ramsey Sedation Scale, first demand time of PCA, postoperative meperidine consumption, side effects and hemodynamic data were also recorded.ResultsThe groups were demographically comparable. Median VAS scores both at rest and on movement were significantly lower in Group NC compared with Group N, except 18th hour on movement (p0.05).ConclusionsThe combination of naproxen sodium‐codeine phosphate provided more effective analgesia than naproxen sodium and did not increase side effects.